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When the Indigo Girls sing, “It took a long time to, become the thing I am to you” clearly they aren’t talking about studying to become an IBCLC, but it certainly applies. As parents go through their own breastfeeding journeys some realize they want to help other people as well. They often start out in Peer-to-peer support, such a vital resource for new families, and soon begin to think about increasing their knowledge and expertise by becoming an IBCLC. Since I did not start out as an RN, nor in a peer support organization, I often have inquiries from people who are interested in chatting with me about the process. Just in the past few months, several women have contacted me to chat so I thought it was the perfect time to write about the process of becoming an IBCLC for someone who is not an RN.

​The IBCLC (International Board Certified Lactation Consultant) title is conferred by IBLCE (the International Board of Lactation Consultant Examiners).

There are many blogs out there describing the various pathways to certification and, as always, it’s important to become completely familiar with the information provided by IBLCE. I’m going to focus on Pathway 3: Mentorship, as that is the route I took to certification. When people reach out to me for information, it is not so much for the facts and details, but rather the experience, the personal take on the journey.​The three criteria IBLCE lists are Health Sciences Education, Lactation Specific Education, and Lactation Specific Clinical Experience. Since the IBCLC exam is the last step, I will add that as the fourth component.

​Health Sciences Education - You will need to determine which courses you are missing based on your own college education. Eight of the courses must be for college credit; the other six may be continuing education.

​​​Thankfully I only needed to take two of the college courses: Human Biology and Nutrition. You can take them at any accredited higher institution, including community college, a local university, or through an online course. I found it easiest to take courses online since I was still working full-time. If you are looking to save money, I do recommend looking into your local community college; they are often less expensive than other colleges and universities.

The continuing education courses may also be taken at a college or university, but you can usually find them online for a better rate. I took mine from Health e-Learning, Lactation Education Resources, and a local CPR course provider. I am not endorsing any particular organization; there are other sources out there as well.

*Tip* Start gathering your transcripts early to ensure you have proof of all courses to fulfill the education requirement.

Lactation Specific Education - All IBCLC candidates, regardless of which Pathway they choose, are required to take at least 90 hours in lactation and breastfeeding education. IBLCE does not recommend specific courses, nor do they approve them in any way. It is your responsibility to be sure the course you take meets the requirements as outlined in the IBLCE Detailed Content Outline.

There are many courses available to you, in-person, online, or as a hybrid. Since I was not coming from a healthcare background, I wanted to have some in-person learning. I chose to go through Breastfeeding Outlook, which provided a hybrid version of the course. I liked that I could go at my own pace for the online seminars and then have a chance to ask questions in person. I asked a lot of questions! This particular course was originally designed for RNs already in the field and there were times that was clear to me, as they spoke in “nurse” language, which is why I needed to ask more questions than anticipated. I believe they received that feedback from other students as well and I’ve heard the course has shifted and it is more accessible to non-RNs now.

Lactation Specific Clinical Experience - Here’s the big one, guys - 500 hours of directly supervised clinical practice. This is the step that is most difficult for those not already working in L&D or as a peer counselor. Where can I get my hours? How will I get them while working full time? Do I need to leave my job? Can I do them part-time? How can my family afford it?

You can find your own mentor (and compensate that person(s) appropriately), or you can go through an organization that sets up mentorships for you, again for compensation. I bring up the compensation right away because many people go into this step thinking they can just find another IBCLC and work with them for free. Having a mentee takes extra time and commitment. If you find your own mentor, expect to create a contract, sign confidentiality agreements, and compensate that person.

I signed up with Lactation Education Resources for their 500-hour Clinical Internship Program. They took me through the steps of having my Pathway 3 plan approved, set up my clinical sites, worked with me to ensure I was gaining experience in a variety of lactation scenarios, and provided additional learning modules. I paid the fee to them and they compensated my mentors as appropriate. They were able to place me in clinical sites I would not have otherwise had access to, which included hospital-based, group private practice, and solo private practice. I believe I received a more thorough clinical education than I would have found on my own.

There are other companies that provide internship placements, so look for one in your area if that is the path you want to take.

​IBCLC Exam​It’s finally time for that final step to which you’ve been working! The IBCLC exam tests your knowledge in the Clinical Competencies set forth in the Detailed Content Outline.

They used to offer the exam once a year, in July. They now offer it twice a year, in April and October. I took the exam in April, so I needed to have my clinical hours completed by mid-November, the deadline for applying for the April exam. All dates are available on the IBLCE site.

There are a variety of practice test books as well as online tests. I highly recommend taking practice tests from at least two different providers. Linda Smith’s review book, Comprehensive Lactation Consultant Exam Review is highly regarded. I also took practice exams through Lactation Education Resources, Breastfeeding Outlook, and the online portion of the Breastfeeding and Human Lactation textbook. They were all different and helped me see where I needed to study and which areas were my strongest.

One week before the exam I stopped studying. I had taken my courses, completed my hours, and spent many months studying. I knew I needed to give my brain a chance to rest before the big exam.

I was nervous the day of the exam, but I also knew I had worked hard to get there and done everything I could to succeed. I didn’t want to say it at the time for fear of jinxing myself, but when I left the test, I felt good. There was nothing on the test that completely threw me for a loop. Yes, there were questions for which I couldn’t decide between two answers, or I wasn’t sure exactly what they were trying to get to, but it was all within expectations. I knew I got questions wrong, but I also felt I did well enough to pass. And then the waiting game...the test is in April, but the results do not come out until mid- to late-June (October to December for the other test window).

Well we know I passed, or I wouldn’t be writing this and working as an IBCLC! Even with my relative confidence that I passed, the wait was not easy. When my results finally came in the mail on June 17, I fell to the ground and cried. I’m not kidding! I felt so much relief after all the work I did, the chances I took, and the financial struggle I created for my family. I was an International Board Certified Lactation Consultant!

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I’ll save the steps of setting up a private practice for another post. That has its own pitfalls and triumphs!

Hopefully I’ve given you some insight into the process of becoming an IBCLC through Pathway 3. Get to know the Pathway 3 Plan Guide well. Know all your requirements for education, for clinicals, for having your plan approved (you have to submit it to IBLCE), and all your dates. Don’t forget to keep track of all your education along the way in case you are audited. None of the steps are hidden, but you are responsible for keeping on top of all dates and requirements.​If you are thinking about becoming an IBCLC, what is your biggest concern?

Ohhhh, We’ve Got Trouble, My Friends, right here in River City! ...With a capital T and that rhymes with B and that stands for Bottle!

You’ve gotten breastfeeding off to a great start; baby is happy, healthy, and gaining well. You’re feeling great about your breastfeeding relationship and that awesome milk you provide. A couple months down the road you decide to give baby and bottle, and she refuses!

For some families, bottles are essential for when the nursing parent goes back to work. For others, it may not be needed every day, but parents want to have some time to run errands, go to appointments, spend time with friends, and be able to leave baby at home. So what do you if baby won’t take a bottle?

For this blog, I will focus on tips and tricks to giving a bottle to a baby who isn’t interested. These tips are not about introducing a bottle to a breastfed baby for the first time, paced bottle feeding, or which type of nipple/bottle to use. We will discuss those topics in future posts. You’ll notice that some of these tips contradict each other. All babies are different, just as their likes and dislikes vary, so what works for one baby may not work for another. Take some time to find what works for you and your baby.

Bottles & Milk

Use a small amount of milk when so that you don’t waste your precious pumped milk

Try slow-flow nipples since baby is more likely used to the slow flow of the breast

​Reverse CyclingSome babies choose not to take a bottle. For short periods of time, they may not need to have milk. For extended time, they may choose to go without milk when away from the breast, and get all their milk in the evening and overnight. This situation may not be ideal, and may be more tiring for the nursing parent, but fortunately baby is still getting all his nutrients and is happy during the day.

Take your timeYour baby cannot be forced into taking a bottle through hunger and persuasion. You may have to work on it over time. It’s ok to let baby play with the bottle and nipple in her mouth, getting used to the idea.

All of these tips are for babies refusing the bottle out of preference for feeding at the breast. If it seems your baby is struggling with a bottle for other reasons, please speak with an IBCLC or your pediatrician to rule out anatomical concerns. Some IBCLCs (including myself) do bottle consults to work with your baby and help you develop a plan for guiding your baby towards taking a bottle. Bottle refusal is yet another time you are not alone. Always reach out for help.

I’ve also included this information in the attached PDF for easy printing and reference.

I am thrilled to share that I am now an in-network provider with Aetna and its subsidiaries. Aetna members are eligible for up to six lactation consults, with no out-of-pocket costs.

While I am happy to be park of the insurance network, I know many of my clients, and many of you out there, are members of other insurance providers. So what does that mean for you? Can you get your lactation consult covered by insurance?

For many new parents, having access to a consult with an IBCLC (International Board Certified Lactation Consultant) is a crucial step in continuing their breastfeeding journey. Several years ago, breastfeeding support, supplies, and counseling were added to the Affordable Care Act. This change in insurance law has made it possible for more parents to get the care they need, however, there are some bumps in the road and coverage is not always available. Understanding how lactation care and insurance intertwine can be confusing, so hopefully I can shed some light on the issues and provide not only resources for getting your consult covered, but also an inside look into the issues facing IBCLCs.

General coverage - While the Affordable Care Act did place lactation coverage into law, there are many companies and plans that are exempted from required coverage, or who have found loopholes around that coverage. They also vary in how much they will cover, and by whom. Some people are able to see an in-network provider, others are are able to get their consult completely reimbursed, and others are reimbursed for some of the cost. Call your own insurance company before seeing a lactation consultant so that you are aware of the coverage extended to you.

In-Network Providers - Each insurance company creates its own rules about how it will credential providers to be in-network with their company. Some allow all IBCLCs to apply, while others require another license, such as RN or LPN. Some companies place a cap on the number of in-network IBCLC providers in a geographic region. If the IBCLC you work with is not in-network, it may due to the limits of the insurance provider.

Remuneration - Just as coverage and network status are governed by each company, so is the payment extended to the IBCLC. We, as IBCLCs, often feel a calling to assist new families with lactation care. We believe in empowering families to continue their breastfeeding journeys as they see fit. It is often a passion, not just a job. That passion is also a way that we financially support our own families. Some insurance companies provide scant remuneration, which can vary across geographic regions. For some IBCLCs, if they were in-network, the amount of remuneration may not allow them to financially support their own families, thus prohibiting them from providing the much-needed lactation support to other families. They may choose to remain out-of-network in order to continue providing care.

Reimbursement- Since the rules are so different across companies, and even within branches of each company, I always suggest that my clients call their insurance companies to discuss what will be covered, and how much will be reimbursed. Most of my clients are reimbursed for some or all of the consult fee. I, and most other IBCLCs, provide each client with what is called a superbill (receipt with insurance codes) that can be sent to an insurance company for reimbursement. We encourage you to submit it, and re-submit if you run into issues receiving reimbursement.

As previously mentioned, if you are unsure of the coverage extended to you, call your insurance company, and reach out to a local IBCLC for guidance. The insurance market is ever-changing. While we don’t know what changes will unfold in the next few years, IBCLCs will continue to promote lactation coverage for all families to ensure equitable care for everyone.

...a very good place to start. When we sing we begin with Do Re Mi, when we breastfeed we begin with position, latch, suck. ​Welcome to the Lactation Life blog! Since this is my first blog post, I thought the perfect topic to discuss is Getting off to the Right Start in Breastfeeding. If you’re reading this post, you have probably already decided to breastfeed. You may be aware of the many benefits to both baby and lactating parent, and you’re looking for guidance on those first hours and days after birth. Becoming a new parent can be overwhelming, and while we ultimately learn by doing, there are a few things to know going into it so that we can be more prepared.

Early and Often - Start breastfeeding as soon as you are able, and breastfeed often. The best way to give your baby what s/he needs and tell your body to make milk is to breastfeed early and often. We recommend breastfeeding 10-12 times in 24 hours. You cannot overfeed a baby at the breast, so let your little one spend lots of time nursing.

Separation from Baby - Sometimes baby is separated from the lactating parent due to medical issues, or recovery from surgery. If you are separated from your baby, start practicing hand expression. Not only does it send a signal to your body to make milk, it also provides expressed colostrum you can feed your baby. Hand expression is a great skill to have for those early hours, for helping relieve engorgement, and for expressing milk as baby grows. If you will be separated for longer periods of time, for example if baby is in the NICU, request a breast pump and start pumping, along with hand expression. Ask the IBCLC and nurses for assistance.

Skin to Skin - Your chest is your baby’s habitat. Spend time skin to skin as often as possible. Is baby tired? Skin to skin! Is baby cold or hot? Skin to skin! Is baby fussy? Skin to skin! Is baby in the room with you? Skin to skin! I think you get the idea. Skin to skin time (that means baby in only a diaper, on direct skin, no bra, no shirt) builds milk supply, reduces stress, and regulates baby’s temperature and blood sugars.

Positioning and Latch - There are a variety of positions in which to hold your baby when breastfeeding. Ask for assistance from the nurses or hospital IBCLC to try different positions.

Laid back is the most natural position, with baby leading the way, secured on your body, finding the nipple, and latching on. If you have seen the videos of the breast crawl, you’ve seen babies work their way up to this position. This is the position baby instinctively knows.

Cross-cradle is the position you most often see with newborns. This position allows the parent to lead the way, helping the baby open wide to get a big mouthful of breast tissue by positioning baby belly-to-belly and nose-to-nipple. As we often say, it is not nipple feeding, it is breast feeding. You want baby to get a deep latch.

Football is similar to cross-cradle in that it is parent led. In this case, baby is on the lactating parent’s side, belly-to-side, and still nose-to-nipple to get a deep latch. For lactating parents with large breasts, this position is often the most comfortable.

Is my baby getting enough? This is a common question and concern in those early days. Your nurses and pediatrician will guide you in watching for wet and dirty diapers, as well as weighing the baby to determine weight loss and gain. Weight loss is expected in the first few days; sometimes when IV fluids were used during labor and delivery, we see higher weight loss due to an elevated weight from the fluids. Nurse often!

✭Seek Help✭You’ll hear people say that breastfeeding always hurts at first and you just need to tough it out. Please do not suffer through pain!Yes, there may be some discomfort at first, however, pain is a sign of an issue. If you are having trouble latching, experiencing pain, or baby is not gaining weight, seek the help of an International Board Certified Lactation Consultant (IBCLC). An IBCLC is specially trained to help guide you through what is normal, assess you and baby, and work with you to determine the issues and solutions.

Breastfeeding is a natural part of life, but that doesn't mean there isn't a learning curve. I often tell parents that walking is natural too, but we fall down as we learn to walk. Seek guidance and help when needed, give it time to all come together, and enjoy those quiet moments with your newborn.